Efficiency trends of essential public health services and possible influencing factors since the new round health reform in China: a case study from Hainan Province.

Objective: This article aimed to evaluate the efficiency trends and influencing factors of essential public health services in Hainan Province after the healthcare reform launched in 2009 in China. Methods: The efficiency of essential public health services (EPHS) at primary health institutions was assessed using data envelopment analysis (DEA), and the efficiency change was analyzed by employing the Malmquist productivity index (MPI). We used Tobit regression to identify the influence of environmental factors on the efficiency of public health services. The bootstrap method was adopted to reduce the impact of random errors on the result. Results: The bootstrapping bias-corrected efficiency revealed that the average values of technical efficiency, pure technical efficiency, and scale efficiency were 0.7582, 0.8439, and 0.8997, respectively, which meant that the EPHS in Hainan Province were not at the most effective state. The average bias-corrected MPI was 1.0407 between 2010 and 2011 and 1.7404 between 2011 and 2012. MPIs were less than 1.0000 during other periods investigated, ranging from 0.8948 to 0.9714, indicating that the efficiency of EPHS has been decreasing since 2013. The Tobit regression showed that the regression coefficients of per capita GDP, population density, the proportion of older people aged over 65, and the proportion of ethnic minority population were 0.0286, -0.0003, -0.0316, and - 0.0041 respectively, which were statistically significant (p < 0.05). Conclusion: There was a short-term improvement in the efficiency of EPHS in Hainan after the launch of the new round of health reform. However, this trend has not been sustained after 2013. In particular, equalized financial investment in essential public health could not fulfill the needs of poor counties. This has resulted in the inability to improve scale efficiency in some counties, which in turn has affected the improvement of overall EPHS efficiency. Therefore, to promote EPHS efficiency sustainably, it is suggested that under this model of provincial control of counties, the equity of resource allocation should be effectively improved while further advancing the technology of service delivery.

Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model.

BACKGROUND: Venous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients. METHODS: This study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed. RESULTS: A total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis). CONCLUSION: This study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen.

Wild­type blocking pcr coupled with internal competitive amplified fragment improved the detection of rare mutation of KRAS.

Mutant KRAS proto­oncogene GTPase (KRAS) serves an important role in predicting the development, diagnosis, treatment and efficacy of targeted drug therapies for colorectal cancer. To improve the detection efficacy of trace amount of mutant KRAS, the locked nucleic acid­based method was modified in the present study. Internal competitive amplification fragments were used to improve the inhibition of wild­type KRAS with a wild­type blocking (WTB) probe and specifically amplify the trace amounts of mutant KRAS. The modified method, quantitative clamp­based polymerase chain reaction technology using WTB coupled with internal competitive reference to enhance the amplification specificity, named WIRE­PCR, completely blocked the amplification of wild­type KRAS in 50­150 ng DNA templates. The added internal competitive amplified fragments were amplified together with the target gene, which were used to reduce base mismatch due to the high number of cycles in PCR and quantify the total amount of DNA. The results demonstrated that WIRE­PCR facilitated the detection of mutated alleles at a single molecular level. In the colorectal biopsies from 50 patients with suspected colorectal cancer, 18 cases (36%) contained mutant KRAS, and the amount of mutant DNA accounted for 18.6­64.2% of the total DNA. WIRE­PCR is a simple, rapid and low­cost quantitative analysis method for the detection of trace amounts of the mutant KRAS.

[Spatial pattern evolution of carbon emission intensity from energy consumption in China].

Using Theil index and spatial autocorrelation analysis methods, the characteristics, regional disparity and spatial pattern evolution of carbon emission intensity from energy consumption were analyzed on national, regional and provincial level from 1999 to 2007 in China. The results indicate that: (1) total energy carbon emission in China has increased from 0.91Gt in 1999 to 1.83Gt in 2007, while carbon emission intensity has decreased from 0.83 t x (10(4) yuan) (-1) to 0.79 t x (10(4) yuan) (-1); (2) carbon emission intensity of eight major economic blocks showed the trend of three-level differentiation, with that of northeast regions, the middle reaches of Yellow River regions and northwest regions above 1.0 t x (10(4) yuan)(-1); northern coastal regions, the middle reaches of Yangtze River regions and southwest regions 0.7-1.0 t x (10(4) yuan) (-1); eastern and northern regions 0.32-0.51 t x (10(4) yuan) (-1); (3) Theil index analysis indicates that the within-region carbon emission intensities were similar, and the expanding total disparity of carbon emission intensity was primarily due to between-region inequalities. (4) spatial autocorrelation analysis shows that Global Moran's I has increased from 0.19 to 0.25, indicating that there were positive spatial correlations among provincial regions in China, and regions of similar carbon emission intensity agglomerated in space. The "cold spot" areas of carbon emission intensity were relatively stable, while the "hot spot" areas has gradually shifted from northwest regions to the middle reaches of Yellow River regions and northeast regions. (5) spatial disparity of carbon emission intensity is closely related to factors such as regional resources endowment, economic development, industrial structure and energy utilization efficiency. The study of regional disparity and spatial autocorrelation provides insight into spatial heterogeneity and spatial pattern evolution of carbon emission intensity in China, and also provides references for the development of differential regional objectives of carbon emission reduction and related regulation policies.